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Is BC/BS Practicing Medicine? By Gregory Paweleski

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I’ve observed the incessant complaints on various cancer blogs and discussion boards about BC/BS "denial of coverage" on the backs of injured and diseased human beings during their fight with the great crab.

In one case, the patient was denied a CT scan. As the poster said, "because BC/BS is practicing medicine and deciding that such a thing is not medically necessary." Without the CT scan, there was no way for the doctor to definitively tell if a swollen leg is cancer related or a blood clot. The physician couldn’t make a diagnosis based on the best available technique to make that diagnosis.

Another poster presented the case that BC/BS used to cover Pet Scans. Unfortunately, some study came out stating that Pet Scans aren’t more effective than CT Scans to find colon cancer. With that one study, BC/BS had decided not to cover the Pet Scan, even against the physician protest.

Continue reading…

HEALTH2.0: Vertical Search–The only way is up?

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Forrester data in iHealthbeat:

Seventy percent of online consumers surveyed said they have used a Web-based search engine to find health-related information, but just 7% of online consumers surveyed said they have used a health-specific search engine, according to a survey by Forrester Research

That means that the vertical search guys have had 10% of the market in users although surely much less than 10% of the market in traffic. You can see why with the huge CPM rates for health care advertising this is indeed an interesting market for vertical search crowd like Healia, Healthline, Microsoft/Medstory, Kosmix, Praxeon et al. (Yes, I’m using those 5 as examples as they were on the panel at Health2.0 and I am just reviewing the DVD). But there are others too, like Medgle.

So will they gain any traction from this? Or will the big three (or really the big one) simply take their share back with their new tech releases…

POLICY: Friday quiz–A tale of two professors

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I’ve been told that I make “vicious ad hominem attacks” about people I disagree with on matters of substance. So I thought it would be fun to show what some other luminaries say. See if you can guess who wrote this and who they’re talking about—yes both in the same long article and both people with similar roles and titles:

XXX XXX is a professor at XXXX Business School and the thought leader on consumer driven health care in the United States. XXX is the author or editor of three books that laid out the intellectual foundation for the consumer empowerment movement: (book titles redacted). XXX is a frequent and popular lecturer on all aspects of health care reform, and serves on the Boards of some of the most innovative health care companies in America.

Continue reading…

HEALTH PLANS: Health Plans Behaving Badly

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I spent Monday lecturing a bunch of health plans about their bad behavior and how that had to change or they’d eventually be put out of business. So how might that not play out? Here’s my best guess up at Spot-on. It’s called Health Plans Behaving Badly.

It’s not been too pretty a picture for America’s health insurers lately. Sure they’re still turning decent profits, but for the past two years their stocks have barely been matching the S&P 500 Index. What went wrong? Well, you can blame Wall Street. The Street is concerned with two things. Money now and money later.

Since 2001 the big health plans have managed to increase the percentage they keep of fast-growing health care premiums (which have been going up at 3 to 4 times the rate of inflation), a number known to stock analysts as the as the MLR. It used to be that for most big insurers roughly 82-87% of premiums went out the door to pay for actual doctors, hospitals, drugs et al. Now the MLR is generally below 80%, and in some cases below 75% meaning less money’s out the door and more is on the bottom line of the health plans.

But the health insurer party that’s been going on for most of this decade may be coming to an end. But perhaps being busted by the cops and being told to tidy the house might be the best thing that ever happened to the insurers. Let me explain.

Read the rest and come back here to comment as ever.

Aspen Report 3 – Removing the Blinders: Dr. Kelman’s Wonderful Contribution, Brian Klepper

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One
of the most fascinating and moving experiences at the Aspen Health
Forum – Given the quality of the content there, this is saying
something. The audience was rapt – was a talk by Neen Hunt, Executive
Director of the Lasker Foundation.
Each year this organization bestows a hugely prestigious prize to
individuals who have made significant contributions to scientific
medicine, clinical medicine and public service.

Dr. Hunt’s talk
focused on combating the geeky stereotypes that often are associated
with people with dedicated passions, and on conveying their broad
humanity. Her vehicle was a character portrait of Dr. Charles D.
Kelman, an ophthalmologist practicing in Manhattan during the latter
half of the 1900s, who in an incredibly bold stroke, blew past
convention, inciting the wrath of those tied to the established order,
and revolutionized the way that cataract surgeries are performed.

Continue reading…

PODCAST: Overtreated–Shannon Brownlee explains all

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Overtreated is a marvelous new book by Shannon Brownlee. Shannon is a former US News & World Report health reporter, and now is a Fellow at the New America Foundation (that’s the centrist third way Clintonite Dem one). In the book she’s essentially trying to channel Jack Wennberg for the masses, and you all know how important that is.

I spoke to her about the book, changing the perception about what Americans think about the power of medicine, and how journalists haven’t got much chance of changing what they write about health. It was a great conversation.

TECH/HEALTH2.0: Marissa Mayer speaks Google Health

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At Web2.0 Summit yesterday (no, Matthew isn’t important enough to be invited to apply for a ticket, but I met a VC for lunch there so I knew it was happening!) Google’s new (and presumably temporary) head of health care Marissa Mayer gave some more details about what’s coming.

First, it’s supposed to be arriving in early 2008.

Second it’s going to have in it the already leaked PHR components, and it will include a rumored (but I don’t think confirmed to this point), physician directory. More interestingly apparently While some parts of the system will be free, she says, the health care services and applications could be subscription-based.

Google hasn’t really done subscription based services to this point, and consumers haven’t exactly flocked to them in heath care as yet. So what they’re thinking about there I’m curious to know.

I’m also wondering what’s happening in the 90 minute all hands meetings Marissa has every day with the Google health team!

But of course so long as Google owns search and search owns the Internet, what they decide to do in health care is about as important as anything—hence our continued fascination.

CODA: By the way, Richard Martin, the scribe at Information Week is probably causing the Redmond PR folks to be pulling their hair out. He says, Microsoft has not publicly disclosed its plans for a health-related product, but is said to be working on an offering that combines software with an online component. Given the attention lavished on a lowly blogger to make sure I knew all about the health piece of Live Search and Healthvault launch earlier this month, I’m sure someone at Information Week should have caught wind of Microsoft’s activity!

HOSPITALS: Why We Don‘t Have Enough Nurses (It’s Not Low Wages) By Maggie Mahar

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THCB contributor Maggie Mahar returns today with another of her insightful pieces on the business  of healthcare. If you haven’t yet done so, you are hereby commanded – yes, as in that’s an order – you should go pick up your copy of Money Driven Medicine: The Real Reason Healthcare costs so much, Maggie’s recent study of the forces at work in the  healthcare marketplace.

Consider
this: In the San Francisco area, a nurse with a bachelor’s degree can
hope to start out with a salary of $104,000. The salary for a nursing
professor with a Ph.D. at University of California San Francisco starts
at about $60,000.

This goes a long way toward explaining why nursing schools turned
away 42,000 qualified applications in 2006-2007—even as U.S. hospitals
scramble to find nurses. We don’t have enough teachers in nursing
schools and the fact that the average nursing professor is nearly 59
while the average assistant professor is about 52 suggests that, as
they retire, the shortage could turn into a crisis. The most recent issue of JAMA (October
10, 1007) reports that in 2005 we had 218,800 fewer nurses than we
needed and by 2012, it’s estimated that we’ll be short some 1 million
nurses.

Hospitals have had to raise nursing salaries (as well they should),
not just because nurses are scarce but because, in our chaotic hospital
system, the work can be extraordinarily stressful.   

Nurses know better than anyone just how many “adverse events” occur each day –even in the most prestigious U.S. hospitals.

“I’m terrified of killing someone,” one young nurse confided to me
about a year ago. After working in a hospital in Bermuda for a number
of years, she was bored, and had come back to work in New York, where
she had friends and family. She had worked in New York before, but she
wasn’t at all sure that she would stay. “In our hospitals, it’s just
too crazy,” she said.

Her story also sheds light on why nursing professors are willing to
work for $60,000 a year when they could, no doubt, more than double
their salaries if they were willing to wade into the fray at local
hospitals.

Continue reading post at HealthBeat

HEALTH 2.0: Sermo CEO Daniel Palestrant

Monday’s announcement that Sermo, the social
networking site for doctors, is teaming up with Pfizer has left the company one
of the most-talked about tech startups in the country. In this clip from
September’s Health 2.0 conference, Sermo CEO Daniel Palestrant introduces his
company’s business model and walks viewers on a guided tour through the Sermo
web site , talking about the reasons "the wisdom of crowds" promises
to be a potent force in medicine. 

assetto corsa mods